Medical graduates' early career choices of specialty and their eventual specialty destinations: UK prospective cohort studies.

OBJECTIVE: To report on doctors' early choices of specialty at selected intervals after qualification, and eventual career destinations. DESIGN: Questionnaire surveys. SETTING: United Kingdom. PARTICIPANTS: Total of 15 759 doctors who qualified in 1974, 1977, 1983, 1993, and 1996, and their career destinations 10 years after graduation. RESULTS: 15 759 doctors were surveyed one and three years after graduation and 12 108 five years after graduation. Career preferences at years 1, 3, and 5, and destinations at 10 years, were known for, respectively, 64% (n=10 154), 62% (n=9702), and 61% (n=7429) of the survey population. In the 1993 and 1996 cohorts, career destinations matched with year 1 choices for 54% (1890/3508) of doctors in year 1, 70% (2494/3579) in year 3, and 83% (2916/3524) in year 5. Corresponding results for the earlier cohorts (1974-83) were similar: 53% (3310/6264), 74% (4233/5752), and 82% (2976/3646). The match rates varied by specialty; for example, the rates were consistently high for surgery. Career destinations matched with year 1 choices for 74% (722/982) of doctors who specified a definite (rather than probable or uncertain) specialty choice in their first postgraduate year. About half of those who chose a hospital specialty but did not eventually work in it were working in general practice by year 10. CONCLUSIONS: Ten years after qualification about a quarter of doctors were working in a specialty that was different from the one chosen in their third year after graduation. This stayed reasonably constant across graduation cohorts despite the changes in training programmes over time. Subject to the availability of training posts, postgraduate training should permit those who have made early, definite choices to progress quickly into their chosen specialty, while recognising the need for flexibility for those who choose later.

Career choices for paediatrics: national surveys of graduates of 1974-2002 from UK medical schools.

BACKGROUND: Knowledge of UK doctors' career intentions and pathways is essential for understanding future workforce requirements. The aim of this study was to report career choices for and career progression in paediatrics in the UK. METHODS: Postal questionnaire surveys of qualifiers from all UK medical schools in nine qualification years since 1974. RESULTS: In total, 74% (24 621/33 412) and 73% (20 720/28 459) of doctors responded at 1 and 3 years after graduation. Choices for paediatrics 1 year after qualifying fell from 7.8% of 1974 graduates to 5.0% of 1983 graduates, increased to 7.2% of 1993 graduates, and since the level has remained fairly constant. Approximately twice the percentage of women graduates than men graduates indicated a long-term career choice for paediatrics. A total of 44% of those who chose paediatrics 1 year after graduation were working in it 10 years after qualifying. Experience of the subject as a student, and enthusiasm/commitment: what I really want to do, affected long-term career choices more for paediatrics than for other medical careers. CONCLUSIONS: The proportion of junior doctors wishing to become paediatricians has not changed much during the last 30 years. The planned increase in the number of medical school graduates is necessary to increase the number of UK-trained consultant paediatricians. Medical students who experience enthusiastic and stimulating training in paediatrics may be more likely to become paediatricians.

Career choices for radiology: national surveys of graduates of 1974-2002 from UK medical schools.

AIM: To report on trends in career choices for radiology among UK medical graduates. MATERIALS AND METHODS: One and 3 years after graduation, and at longer time intervals thereafter, postal questionnaire surveys were sent to all doctors who graduated from UK medical schools in 1974, 1977, 1980, 1983, 1993, 1996, 1999, 2000 and 2002. Doctors were asked to specify their choice of long-term career and to identify factors influencing their choice. Employment details were also collected. Results were analysed using chi(2) statistics and binary logistic regression. RESULTS: Seventy-four percent (24,621/33,412) and 73% (20,720/28,459) of doctors responded 1 and 3 years after graduation. Choices for radiology in year 1 increased significantly over time (1.7% of 1974 graduates to 3.2% of 2002 graduates; chi(2) test for trend=15.3, p<0.001). In particular, there has been a steady increase from the cohorts of 1993 onwards. Thirty-eight percent of those who chose radiology in year 1, and 80% who chose radiology in year 3, were still working in radiology 10 years after graduation. Hours and working conditions influenced long-term career choices more for radiology than for other careers. CONCLUSIONS: The proportion of UK trained junior doctors who want to become radiologists has increased in recent years. However, although medical school intake and the numbers making an early choice for radiology have risen, it is unclear whether sufficient UK graduates will be attracted to radiology to fulfil future service requirements from UK trained graduates alone.

Career choices for obstetrics and gynaecology: national surveys of graduates of 1974-2002 from UK medical schools.

OBJECTIVE: To report the trends in career choices for obstetrics and gynaecology among UK medical graduates. DESIGN: Postal questionnaire surveys of qualifiers from all UK medical schools in nine qualification years since 1974. SETTING: United Kingdom. POPULATION: All graduates from UK medical schools in 1974, 1977, 1980, 1983, 1993, 1996, 1999, 2000 and 2002. METHODS: Postal questionnaire surveys. MAIN OUTCOME MEASURES: Career choices for obstetrics and gynaecology and factors influencing career choices for obstetrics and gynaecology. RESULTS: Seventy-four percent (24,623/33,417) and 73% (20,709/28,468) of doctors responded at 1 and 3 years after qualification. Choices for obstetrics and gynaecology fell sharply during the 1990s from 4.2% of 1996 qualifiers to 2.2% of 1999 qualifiers, and rose slightly to 2.8% of 2002 qualifiers. Only 0.8% of male graduates of 2002 chose obstetrics and gynaecology compared with 4.1% of women. Forty-six percent of those who chose obstetrics and gynaecology 1 year after qualification were working in it 10 years after qualifying. Experience of the subject as a student, and the influence of a particular teacher or department, affected long-term career choices more for obstetrics and gynaecology than for other careers. CONCLUSIONS: The unwillingness of young doctors to enter obstetrics and gynaecology may be attributable to concerns about workforce planning and career progression problems, rather than any lack of enthusiasm for the specialty. The number of men choosing obstetrics and gynaecology is now very small; the reasons and the future role of men in the specialty need to be debated.

Progression of junior doctors into higher specialist training.

OBJECTIVES: To report on the transition of junior doctors into higher specialist training in the UK, following the Calman reforms and recent initiatives to promote training in general practice. Design and setting Postal questionnaire survey carried out in the UK. PARTICIPANTS: All graduates of 1996 from UK medical schools were surveyed in 2002. MAIN OUTCOME MEASURES: Outcome measures were considered to be details of applications, outcomes of applications, intentions to apply for specialist training, and career plans with regard to such issues as flexible training and work. RESULTS: Of 2312 responders, 39% had applied for specialist registrar (SpR) training and 35% for general practice (GP) training. Of applicants for SpR training, 68% were successful; 24% failed, almost all of whom intended to reapply, many after gaining research experience; 4% awaited a decision, and 4% had had another outcome (e.g. they withdrew their application). A sixth of responders intended to apply but had not yet done so. Of applicants for GP training, 95% had been successful. A further 2% intended to apply but had not yet done so. Responders viewed flexible and part-time training and work opportunities, and information about available posts, as being more widely available in general practice than in hospital practice. Half of the responders did not agree that their postgraduate training had been of a high standard. CONCLUSIONS: Progression into GP training seemed to have been a smoother and less protracted process than that into SpR training. Delayed applications for SpR training were common, and many of those who had applied had not been accepted. The use of research experience to strengthen a re-application was common.

Emmetropisation in normal and strabismic children and the associated changes of anisometropia.

The purpose of this study was to measure whether emmetropisation failed in children who had strabismus irrespective of their refraction in infancy, and to record simultaneous changes in anisometropia. We also report how often hypermetropia increased before these children presented with esotropia. A total of 2920 infants had a cycloplegic retinoscopy at age 5-7 months and again at 42 months or when defective vision was identified. Changes of refraction in 210 children with strabismus are compared with the remaining 2710 who did not. When the spherical equivalent of the fixing eyes was > +2.75 D in infancy, hypermetropia decreased less in both eyes of those who had microtropia (p <.001) and heterotropia (p <.001) than in normal children. When it was < +2.75 D, the spherical and/or cylindrical refraction more often remained outside the 'normal' range in both eyes of those who had microtropia and heterotropia (p <.05). Emmetropisation was deficient in both eyes of at least 80% of these strabismic children irrespective of their refraction in infancy. Furthermore, in the strabismic children, the mean change of refraction was less (p <.05) in their fellow eyes than in their fixing eyes, the difference between the two eyes being on average three times greater than that in those who had normal vision. Thus, anisometropia increased in 53% of those who had strabismus but remained within normal limits (< ca. 0.75 D spherical equivalent) in 94 % of those who did not. 'Abnormal' anisometropia in infancy did not, per se, permanently affect vision because 72% of all those who had it did not have strabismus. Finally, the spherical hypermetropia of fixing eyes increased in only 35% of the children with esotropia - similar to the incidence in those who had a microtropia (p =.36). This does not obviously support the concept that increasing hypermetropia causes accommodation to increase before convergence.

Reduction of astigmatism after infancy in children who did and did not wear glasses and have strabismus.

The purpose of this study was to record and explain the changes in astigmatism as normal and strabismic infants grew. Two-hundred-and-eighty-nine hypermetropic infants were randomly allocated to wear glasses from the age of six months. Changes in astigmatism and in hypermetropia of the horizontal and vertical meridia were compared in those who did and did not wear glasses and have strabismus. Mean astigmatism decreased significantly (p < 0.001) in both eyes of normal and strabismic children, but the 'last' astigmatism was significantly (p < 0.001) larger in both eyes of those who had strabismus. There was a similar progressive decrease of hypermetropia in both meridia of both eyes within each diagnostic group, but with the exception of the vertical meridian of the non-fixating eyes (in which the difference approached statistical significance), this was significantly (p < 0.01) larger in the normal children. The consistent wear of glasses was not associated with change in both meridia of both eyes in the normal children (p < 0.005), but had no significant effect on the changes in astigmatism. Since the changes in the two meridia were proportional to the starting level, hypermetropia decreased more in the meridian which was, initially, the more hypermetropic one, and the difference between them, i.e. astigmatism, tended to disappear whether or not the child eventually had strabismus.

Graduate status and age at entry to medical school as predictors of doctors' choice of long-term career.

OBJECTIVE: To determine whether graduate entry to medical school, taking an intercalated degree during medical school, and age at entry to medical school are related to choice of eventual career. DESIGN: Postal questionnaires. SETTING: United Kingdom (UK). SUBJECTS: All doctors who qualified in the UK in 1993 or 1996. RESULTS: We analysed whether graduate status and age on entry to medical school, and taking an intercalated degree during medical school, were predictors of the choice of eventual career, adjusting for differences by sex, year of qualification and medical school. General practice was the career choice of 27.0% (79/293) of graduate entrants and 21.6% (1095/5073) of non-graduate entrants, a difference of borderline significance (P=0.04). Of the non-graduate entrants, general practice was the career choice of 15.3% (319/2081) of doctors who took an intercalated degree and 25.9% (776/2992) of doctors who did not (P < 0.001). Within the hospital specialties, those who took an intercalated degree were more likely than others to choose the hospital medical specialties or pathology. Age alone was not a predictor for choice of any area of practice. CONCLUSIONS: There was no evidence of an association between age at entry to medical school and choice of eventual career. Graduates at entry to medical school were a little more likely than non-graduates to choose general practice but the relationship was not a strong one. In these respects, changing the entry profile of medical students is unlikely to result in major shifts of career choice towards general practice.

Loss of British-trained doctors from the medical workforce in Great Britain.

OBJECTIVE: To summarize trends over time in the percentage of British medical graduates who subsequently practise in Great Britain in the National Health Service (NHS), in Great Britain outside the NHS, outside Great Britain, or do not practise medicine. DESIGN: Questionnaire-based postal surveys and government employment records. SETTING: Great Britain. SUBJECTS: All British medical graduates of 1974, 1977, 1983, 1988, and 1993. MAIN OUTCOME MEASURES: Type and location of employment at successive years after graduation. RESULTS: Differences in career destination between cohorts were generally small. Combining data from all cohorts studied, 85% of doctors were working in the NHS 2 years after graduation, 82% after 5 and 10 years, 81% after 15 years, and 77% after 20 years. Part-time working was much higher among women than among men. Allowing for loss and part-time working, the whole-time equivalent available to the NHS at 15 years after graduation was 60% of women and 80% of men. More men than women worked in medicine outside the NHS in Britain and abroad. Loss from medicine altogether was small, and higher among women. CONCLUSIONS: Medical workforce planning in Great Britain should assume that 15-20% of home-trained doctors will not be working in the NHS within a few years of graduation. Comparing cohorts at the same career stage showed no evidence of increased loss from the NHS in recent times. Although a higher percentage of women than men were not working in medicine at all, recent trends suggest that this percentage is falling.

A prescription for health: a primary care based intervention to maintain the non-smoking status of young people.

OBJECTIVES: To evaluate the effectiveness of primary health care teams in maintaining a group of young people aged 10--15 years as non-smokers. DESIGN: Randomised controlled trial using postal questionnaires. SETTING: Oxfordshire, UK. SUBJECTS: 2942 young people who were initially self declared non-smokers. INTERVENTION: Information about smoking, sent under signature of the subject's general practitioner, certificates and posters intended to reinforce non-smoking behaviour. MAIN OUTCOME MEASURES: Changes in smoking behaviour, attitudes measured after one year. RESULTS: After a year, smoking uptake was 7.8% in the control group compared with 5.1% in the intervention group (odds ratio (OR) 1.6, 95% confidence interval (CI) 1.1 to 2.2). Among boys the corresponding results were 5.2% and 2.4% (OR 2.3, 95% CI 1.2 to 4.6), and among girls 10.0% and 7.5% (OR 1.4, 95% CI 0.9 to 2.1). Among boys aged 14-15 the uptake rate was 12.8% in the control group compared with 5.4% in the intervention group. However, among girls of the same age the intervention was less effective, with smoking uptake of 15.1% in the control group and 12.8% in the intervention group. The intervention was more effective among young people whose initial attitudes identified them as definite non-smokers than those who were potential smokers. CONCLUSIONS: The intervention substantially reduced smoking uptake among the young people, particularly boys. Primary health care teams can play an important role in maintaining the non-smoking status of their young patients. Confidential postal contact from the doctor direct to the young person at home is influential and cost-effective.

Retirement intentions of doctors who qualified in the United Kingdom in 1974: postal questionnaire survey.

BACKGROUND: Medical workforce planning needs to be informed by knowledge about doctors' retirement intentions. Systematic information about retirement intentions, and factors that influence them, is sparse. METHODS: Postal questionnaires were sent to members of a cohort of medical qualifiers surveyed regularly since they qualified in 1974, with quantitative analysis of intentions about early retirement and qualitative analysis of reasons for wanting early retirement. RESULTS: A total of 1717 replies were received from 2217 traceable doctors (77.4 per cent). Of these, 1427 doctors worked in the NHS and answered the question about retirement: 14.8 per cent (211) said that they would definitely continue to normal retirement age and 20.1 per cent (287) probably would. Of those not definitely continuing to normal retirement age, 45.1 per cent had made financial provision to support early retirement, Seventy per cent cited reasons for considering early retirement: the main reasons were to reduce work-related pressure, increase leisure time, job dissatisfaction, disillusionment with the NHS, and wanting a healthy retirement. Doctors might be encouraged to stay by more flexible working patterns, a reduction in workload with increasing age, improved staffing levels, preservation of pension rights for part-time working, fewer NHS administrative changes, and greater professional freedom. CONCLUSION: The impact of early retirement on medical workforce supply may be considerable. Approaches to retirement policy need to shift away from the extremes of either full-time employment or total retirement.

Stability and change in career choices of junior doctors: postal questionnaire surveys of the United Kingdom qualifiers of 1993.

OBJECTIVE: To report on stability and change in career choices of doctors, between 1 and 3 years after qualification. DESIGN: Postal questionnaire surveys. SETTING: United Kingdom. SUBJECTS: All doctors who qualified in the United Kingdom in 1993. MAIN OUTCOME MEASURES: Choices of eventual career expressed 1 and 3 years after qualifying. RESULTS: The overall pattern of career choices at year 3 differed a little from that at year 1. For example, choices for general practice increased from 26% to 29%, choices for medical specialties fell from 22% to 18%, and for surgical specialties they fell from 17% to 14%. However, because changes of choice between specialties tended to 'cancel out', the aggregated data masked much larger changes when considered at the level of individual doctors. Overall, 74% of respondents retained their year 1 career choice in year 3 (78% of men, 70% of women). Of doctors who chose a hospital specialty in year 1, 71% chose the same specialty in year 3, 18% had switched choice to another hospital specialty, and 9% had switched choice to general practice. The percentage who changed choice from hospital specialties to general practice between years 1 and 3 was lower in the 1993 cohort than in all previous cohorts. Of those whose year 1 choice of long-term career was general practice, 89% retained that choice in year 3 and 11% switched to other branches of medicine. Even by year 3, less than half of all respondents (and a smaller percentage of women than men) signified that their long-term choice of specialty was definite. In year 3, 78% of all respondents, and 79% of doctors from homes in the United Kingdom, intended definitely or probably to practise medicine in the United Kingdom for the foreseeable future, which represented little change from the figures in year 1. CONCLUSIONS: About a quarter of doctors change their career choice between years 1 and 3 after qualification, and less than half regard their choice in year 3 as definite. Flexibility is therefore needed, well beyond the first post-qualification year, to accommodate changes of choice. Where training opportunities in a hospital specialty are limited, doctors are now inclining, more than in the past, to switch to an alternative hospital specialty rather than to general practice.

Views of junior doctors about their work: survey of qualifiers of 1993 and 1996 from United Kingdom medical schools.

OBJECTIVE: To investigate the views of junior doctors about their work. DESIGN: Postal questionnaire surveys. SETTING: United Kingdom. SUBJECTS: Doctors who graduated from medical schools in the United Kingdom in 1996, surveyed at the end of their preregistration year (2926 respondents), and graduates of 1993 surveyed 3 years after qualification (2541 respondents). RESULTS: Almost 70% of the 1996 qualifiers felt that they worked excessive hours and 80% felt that they undertook too many routine non-clinical duties. Only 24% agreed that their postgraduate training was of a high standard and 22% felt they were being asked to perform clinical tasks with inadequate training. A total of 70% were dissatisfied with arrangements for cover for absent doctors. Senior doctors and nurses were regarded as supportive by most respondents, but hospital management was not. Although 65% were satisfied with their future prospects, only 36% had been able to obtain useful careers advice. Job enjoyment was reasonably high, with two-thirds scoring 6 or more on a scale from 1 (not enjoying at all) to 10 (greatly enjoying), but 70% of respondents felt that they had insufficient time for family and social activities. A briefer questionnaire sent to the 1993 qualifiers in 1996 showed similar results. CONCLUSIONS: More needs to be done to ensure that junior doctors are trained appropriately for the tasks they undertake, to ensure that they regard their training highly, to reduce excessive non-clinical work, and to provide reasonable working hours and cover.

Views of UK medical graduates about flexible and part-time working in medicine: a qualitative study.

OBJECTIVES: To report on the views of doctors about flexible and part-time working in medicine. DESIGN: As part of ongoing studies of doctors' careers, postal questionnaires were sent in 1995 and 1996 to all doctors who qualified from UK medical schools in 1977, 1988 and 1993. Structured questions about recipients' careers were accompanied by a form which invited free-text comment. Comments about flexible and part-time working were extracted for analysis. SUBJECTS: All respondents who commented on flexible and part-time working. RESULTS: Most doctors who commented believed there were insufficient opportunities to meet demand. They also commonly commented that there was not enough information about flexible training opportunities. Some men, as well as women, expressed a wish to work part-time. The most frequently cited reasons for part-time working were to balance career with family responsibilities, and to reduce work-related stress. Cited disadvantages of part-time working were mainly financial and included the problems of paying for childcare and professional subscriptions when on a reduced income. Some respondents perceived negative attitudes towards doctors in part-time jobs. DISCUSSION: It is well-recognised that more flexible medical career structures are needed so that doctors can vary their time commitment according to their needs at particular stages in their lives. Until recently, needs have not been adequately met. Changes in arrangements for flexible training accompanying the implementation of the specialist registrar grade may have begun to alleviate some of the problems, but others, such as negative attitudes towards part-time work, may take time to change.

Effect of spectacles on changes of spherical hypermetropia in infants who did, and did not, have strabismus.

AIM: To explore why emmetropisation fails in children who have strabismus. METHODS: 289 hypermetropic infants were randomly allocated spectacles and followed. Changes in spherical hypermetropia were compared in those who had strabismus and those who did not. The effect of wearing glasses on these changes was assessed using t tests and regression analysis. RESULTS: Mean spherical hypermetropia decreased in both eyes of "normal" children (p<0.001). The consistent wearing of glasses impeded this process in both eyes (p<0.007). In the children with strabismus, there were no significant changes in either eye, irrespective of treatment (p>0. 05). CONCLUSIONS: In contrast with normal infants, neither eye of those who had strabismus emmetropised, irrespective of whether the incoming vision was clear or blurred. It is suggested that these eyes did not "recognise" the signal of blurred vision, and that they remained long sighted because they were destined to squint. Hence, the children did not squint because they were long sighted, and glasses did not prevent them squinting.

Career choices at the end of the pre-registration year of doctors who qualified in the united kingdom in 1996.

OBJECTIVE: To report the career intentions one year after qualification of doctors who qualified in the United Kingdom (UK) in 1996, and to compare their intentions with those of 1993 qualifiers at the same stage. DESIGN: Postal questionnaires. SETTING: United Kingdom. SUBJECTS: All doctors who qualified in the UK in 1996. MAIN OUTCOME MEASURES: Choices of eventual career expressed one year after qualifying. RESULTS: We report on detailed choices of long-term careers for all specialties. Only 20% of 1996 respondents chose general practice compared with 25.8% of 1993 respondents. The percentage choosing general practice fell more sharply among women, from 34.0% to 25.2%, than among men, from 17.5% to 14.1%. Choices for surgical specialties rose from 16.9% of 1993 respondents to 21. 4% of 1996 respondents. The percentage choosing the surgical specialties rose among women, from 7.8% to 11.6%, compared with a rise among men from 26.1% to 32.2%. The percentage of respondents who definitely or probably intended to pursue a long-term career in the UK was 77.7% compared with 75.7% of 1993 respondents. Most of the home-based respondents who had doubts about practising in the United Kingdom were considering practising abroad. Only 1% made an explicit first choice for a non-medical career. However, in all, 9. 4% said that there was a possibility that they might leave medicine. CONCLUSION: The substantial decline in intentions to enter general practice among newly qualified doctors, seen in the 1993 qualifiers, is continued in the 1996 qualifiers. A shortfall in recruitment of UK-trained doctors to general practice is the likely outcome. The rise in choices for the surgical specialties, particularly among women, may herald a renewed interest in hospital specialist training following the Calman changes. It is worrying that almost a quarter of respondents indicated some doubts about pursuing a medical career in the UK.

Career pathways and destinations 18 years on among doctors who qualified in the United Kingdom in 1977: postal questionnaire survey.

OBJECTIVE: To determine the career destinations, by 1995, of doctors who qualified in the United Kingdom in 1977; the relation between their destinations and early career choice; and their intentions regarding retirement age. DESIGN: Postal questionnaire. SETTING: United Kingdom. SUBJECTS: All (n=3135) medical qualifiers of 1977. MAIN OUTCOME MEASURES: Current employment; year by year trends in the percentage of doctors who worked in the NHS, in other medical posts in the United Kingdom, abroad, in non-medical posts, outside medicine, and in part time work; intentions regarding retirement age. RESULTS: After about 12 years the distribution of respondents by type of employment, and, for women, the percentage of doctors in part time rather than full time medical work, had stabilised. Of all 2997 qualifiers from medical schools in Great Britain, 2399 (80.0% (95% confidence interval 79.5% to 80.6%)) were working in medicine in the NHS in Great Britain 18 years after qualifying. Almost half the women (318/656) worked in the NHS part time. Of 1714 doctors in the NHS, 1125 intended to work in the NHS until normal retirement age, 392 did not, and 197 were undecided. Of the 1548 doctors for whom we had sufficient information, career destinations at 18 years matched the choices made at 1, 3, and 5 years in 58.9% (912), 78.2% (1211), and 86.6% (1341) of cases respectively. CONCLUSIONS: Planning for the medical workforce needs to be supported by information about doctors' career plans, destinations, and whole time equivalent years of work. Postgraduate training needs to take account of doctors' eventual choice of specialty (and the timing of this choice).

Career destinations seven years on among doctors who qualified in the United Kingdom in 1988: postal questionnaire survey.

OBJECTIVE: To report the career choices and career destinations in 1995 of doctors who qualified in the United Kingdom in 1988. DESIGN: Postal questionnaire. SETTING: United Kingdom. SUBJECTS: All doctors who qualified in the United Kingdom in 1988. MAIN OUTCOME MEASURES: Current employment. RESULTS: Of the 3724 doctors who were sent questionnaires, eight had died and three declined to participate. Of the remaining 3713 doctors, 2885 (77.7%) replied. 16.9% (608/3593; 95% confidence interval 16.1% to 17.8%) of all 1988 qualifiers from medical schools in Great Britain were not working in the NHS in Great Britain in 1995 compared with 17.0% (624/3674; 16.1% to 17.9%) of the 1983 cohort in 1990. The proportion of doctors working in general practice was lower than in previous cohorts. The percentage of women in general practice (44.3% (528/1192)) substantially exceeded that of men (33.1% (443/1340)). 53% (276/522) of the women in general practice and 20% (98/490) of the women in hospital specialties worked part time. CONCLUSIONS: Concerns about recruitment difficulties in general practice are justified. Women are now entering general practice in greater numbers than men. There is no evidence of a greater exodus from the NHS from the 1988 qualifiers than from earlier cohorts.

Views of doctors in the United Kingdom about their own professional position and the National Health Service reforms.

BACKGROUND: In the course of national studies of doctors' career choices and progression, we received spontaneous comments from respondents about job satisfaction and the National Health Service reforms. To assess whether such comments were representative, or whether they reflected minority views, we added questions to subsequent questionnaires to gauge systematically how doctors view their own professional position and the wider NHS. METHOD: Self-administered questionnaire were sent to all 10,504 qualifiers of 1977, 1988 and 1993 from UK medical schools. RESULTS: A total of 7391 responded (70 per cent). Most doctors in UK medicine were positive about the career opportunities they have had (66 per cent of relevant respondents), their future prospects (68 per cent) and their present position (80 per cent). Few were positive about the NHS reforms (9 per cent) and the effects of the reforms on their own professional work (9 per cent). Only 0.2 per cent of the 1993 qualifiers scored their impression of the internal market as 'strongly favourable'. CONCLUSIONS: In recent years the NHS shifted from a collaborative to a competitive model of management of health care with the establishment of an internal market. The great majority of respondents viewed recent changes and the internal market unfavourably. This is not, however, a reflection of more widespread discontent with their work. The majority viewed their own professional opportunities and present position favourably.

Doctors who qualified in the UK between 1974 and 1993: age, gender, nationality, marital status and family formation.

We report on some demographic characteristics of junior doctors in the United Kingdom, studied in six national cohorts of qualifiers between 1974 and 1993. Over the 20 years covered by the data, the percentage of qualifiers who were women increased substantially (from 27% in 1974 to 47% in 1993). Between 1983 and 1993, the number of women qualifiers rose by 242 (a 17% rise) and the number of men fell by 430 (a fall of 18%). Of all doctors, 52% were aged 23 years or less when they qualified and there was no increase over time in mature qualifiers. We report on increases in the percentage of doctors who qualified in the UK but who were born outside it (from 11% to 16%). The percentage of respondents who were married at the end of the first year after qualification declined from 45% in 1974 to 15% in 1993. At 25 years of age, 2% of the women doctors who qualified in 1983 had children compared with 45% of women aged 25 in the general population. Two-thirds of the women doctors had children by their mid-30s.